PROJECT ABSTRACT / SUMMARY Inactivity in individuals with chronic disabilities who use a wheelchair results in significant and costly secondary complications, such as pressure ulcers, obesity, diabetes, osteoporosis, and cardiovascular comorbidities. We propose to develop an interactive telehealth monitoring and biofeedback system to promote physical activity and pressure relief maneuver performance among wheelchair users. In this project we focus on patients with spinal cord injury (SCI) who are at particularly high risk for developing pressure ulcers from sitting too long (31% annual incidence, 85% lifetime incidence). However, the proposed technology is broadly applicable to wheelchair-based telehealth. The proposed technology - which attaches to any wheelchair without modification - has three core components: 1) an activity monitoring system (i.e., detection of wheel-pushes), 2) a pressure relief monitoring system, and 3) reminders and feedback regarding the achievement of pressure relief and physical activity goals. Biofeedback will be delivered locally (to the user) via a smartphone app and remotely (to the clinician) via a secure internet interface. The enabling technologies are innovative sensor systems to monitor wheelchair specific activity patterns but the significant value comes from integrating these novel measurements within a biofeedback system that encourages wheelchair users to actively avoid secondary complications of inactivity and allows care providers to identify at risk patients and intervene efficiently. Existing technologies do not compare with the proposed solution. Products exist to monitor wheelchair seat pressure but these products are costly, cumbersome, and not designed for home use. Products exist to monitor wheelchair specific physical activity but these devices cannot distinguish passive from active wheelchair movement. No existing technology combines these measures with biofeedback and telehealth functionality. The team we have assembled for this collaborative project includes engineers, clinicians, and scientists from BioSensics (a privately held biomedical technology development company) and Rancho Los Amigos National Rehabilitation Center (one of the largest comprehensive rehabilitation centers in the United States). During Phase I of this project we developed and validated a prototype version of wheelchair sensor and smartphone app (Dowling et. al., Wireless Health, 2015; Dowling et. al., Assistive Technologies, In Press). During Phase II we will improve the seat sensor hardware and develop the remote monitoring and telehealth aspects of the proposed system including 1) a secure HIPAA compliant website so patients, caregivers, and clinicians can remotely view activity and pressure relief data, 2) an automated method for pushing alerts to clinicians and caregivers (via SMS or e-mail) if pressure relief or activity goals are not met, and 3) a simple interface so clinicians and caregivers can send telehealth reminders to the wheelchair user?s smartphone app.